Nepal's Health Care System, Part I: Let's Visit a Pharmacy!

It occurs to me that if you're in Nepal, you'll surely get sick at some point. And that means you'll have to navigate the Health Care System, part of which is helpfully shown above. If you're a tourist who stumbled onto this blog while trying to figure out what's wrong with your stomach, my advice would be: Check your guidebook. It'll tell you useful things like "go to CIWEC Clinic," which is an internationally famous traveler's medicine clinic, and since you have health insurance back home and a credit card you won't mind paying the prices. (They're triple the norm, or maybe ten times. I can't remember, because the last time I asked, my wallet jumped up and hit me on the head. Helpful hint: The doctors at CIWEC have outside practices, too, at non-tourist prices.)

But if you live here, what you really do is check sites like WebMD and then go to the local hole-in-the-wall pharmacy to get whatever you've diagnosed yourself with, because living in Nepal has magically turned you into a doctor and if the internet was any faster you'd soon become a specialist. Then they try to sell you Cipro.

This is an actual transcript of my recent trip to our local storefront pharmacy. Incidentally, everything is over-the-counter here. Especially Cipro.

Me: I need some medicine that starts with D. It's kind of like Brucet but with a D. It's for foot pain.

Pharmacy clerk: (showing me Brucet, which is ibuprofen) It's not this?

Me: No, that's Brucet. It starts with D and the pills are little and round. I had the package but I lost it.

Pharmacy Clerk: Do you have a prescription?

Me: A prescription? Ha ha ha, this is Nepal!

All Pharmacy Clerks and Customers in Unison: Ha ha ha ha ha!

Much of this is probably Cipro

Pharmacy Clerk: (Goes to shelf and starts pulling down boxes that start with D) Is it this? Or this? Or this?

Me: No .... no .... no, that's vitamins ... no, that's eye drops ...

Pharmacy Clerk: Or this one.

Me: That's Cipro. It starts with D and it's definitely not Cipro.

Pharmacy Clerk: (Glancing at shelves piled high with dusty pill boxes.) That's all we have.

I don't leave, because success in Nepali is achieved by the patient. (Um, this is definitely not a pun.) Other customers come to the window. They probably get Cipro, because every time you go to the pharmacy you will be offered vitamins and Cipro, which if you're American you'll recall as the super-potent antibiotic to treat terrorist-induced anthrax, but here is used for things like ear wax removal. The pharmacy person ignores me to chat with other pharmacy people, give people Cipro and vitamins, and check Facebook on her cell phone. I stand there patiently and smile. After a few minutes I catch the eye of another Pharmacy Person.

Me: I need a medicine for foot pain that starts with D. It's a little white pill and it's like Brucet but it's not. Also it's not Cipro and it's not anything like Cipro.

Pharmacy Clerk 2:  (Looks at other Pharmacy People. None of them move. Checks cell phone. Apparently Facebook has no updates. Comes over and begins pulling down boxes.) Is it this? Or this?

Me: (reading label) No, that's a vitamin. It starts with D.

Pharmacy Clerk 2: Is it this one?

Me: Yes, that's it! Thanks, you've been so helpful!

And now you know how to get medicine in Nepal. It's actually quite convenient. OK, it won't be so convenient when we all get antibiotic resistance from using Cipro on earwax. But oh well, we can always go to the shamans. My husband had typhoid as a kid and his parents called the shaman, who made him eat the gall bladder of a bear and pigeon poop. At least he didn't get antibiotic resistance. Although he's pretty resistant to another round of bear gall and pigeon poop.

Also available in Nepal: shamans. 
Try this to treat resistant bacteria. 

How Nepal Beats America For Women. Really.

Tharu woman in my family's village. You can bet she votes.
And if she ran for office, her chances would be better than a woman in America.

I make fun of Nepal a fair amount in this random collection of stray musings that serves as my blog, because if you live here and aren't entertained by it you might as well pack up and go home. Unless you're Nepali, of course, in which case (a) you don't have much choice of leaving unless you want to carry bricks in Saudi Arabia, and (b) you at least have the good fortune to be genetically programmed to be perhaps the smiliest group of people on earth, which is evolution's way of saying "I can cope with being Nepali."

I've gotten off topic even before I started, but it's true. Nepalis even smile and laugh when they argue, and when they're really pissed, the smiling and laughing increases. Nature vs. nurture? Well, my kid basically emerged from the womb with a big grin on his face, which is why it took me at least a decade to realize he was arguing with me.

Smile smile smile.
And if you can't, here's where you go
to get your teeth fixed.

So of course I rag on Nepal, which is what Nepalis do too, all the time. It's the national entertainment, along with smiling and laughing. But there are a lot of ways that Nepal beats America, other than the Smile Factor and the Lack of Electricity Factor. There's the Casual Pace of Life Factor, and the Walkable Neighborhood Factor, and the Supporting Small Business Factor, and the Better Public Transportation If You Ignore the Belching Smoke Factor, and the Groovier Clothing Factor, and so on.

The one I'm mentioning here, though, is women's rights.

Huh? Are we talking about the Nepal on THIS planet? 

Well, women don't exactly have more rights in daily life, obviously. Women here are still the household drudge -- even, by and large, if they're a professor or a doctor. But Nepal is beating America in one place that's pretty important: Women in government.

You might think this is because most of the men are off carrying bricks in Saudi Arabia, which may be part of it. But it's a good sign. I mean, I like Nepali men. They smile a lot. I married one, and he's honest and hard-working and doesn't even mind doing dishes, although he may be a little crazy because he came back here after escaping. (So I guess we match on the craziness index. Although he's better about dishes than me. I'm not that crazy.)

But the thing about Nepal is that it gets a lot of things right by accident, like having walkable neighborhoods, but doesn't exactly score high in terms of intentional things, like running a government. What politicians mainly seem to do is squabble, bicker and steal money. So politics in Nepal is a ridiculous mess, but at least it's a ridiculous mess that is starting to let women in. And you can bet that Nepali women know how to carry a broom. Which could come in handy in the halls of power.

Meanwhile in America, almost 100 years after women got the vote, we barely squeak past 18 percent in women's representation. Whereas Nepal is now at 30 percent and 37th in the world for women in office.

Okay, women in power aren't magically wonderful. But it's kind of impossible to be worse than men. Let's hope that when Nepali women politicians go home after a hard day of not writing the constitution, their husbands aren't sitting there waiting for them to bring the tea, whip up a five-course dinner, scrub the dishes alone, and then get up at 5 a.m. to do the whole thing over again while he talks politics with his friends.

So which country in the world elects the most women? The leader is apparently Rwanda, where things got so bad that it seems the women have finally told the guys to move over and get out of the way. The whole list is here, if you want to know where America stands and who else is ahead of us -- like Finland (number 8 and embarrassing the rest of the world as always), Norway and Denmark and Sweden (of course), and New Zealand (number 26 and beating Australia because it has an incentive). They all beat France and the U.K., which Nepal does too, but America is huffing and puffing way back in the line with the United Arab Emirates.

Obviously a list doesn't tell us much. China, Afghanistan and Saudi Arabia also top America in "women's representation," so it's time again to google who the heck said that thing about "Lies, Damn Lies and Statistics." But Nepalis can definitely look at the list and crow. Check out India, Bangladesh, Sri Lanka and Bhutan. All of which are trailing far behind Nepal, America and, er, Saudi Arabia like a sad line of bedraggled ducklings who can barely find the racetrack.

Let's hear it for Nepali women: strong, cool, and increasingly elected to office.

Women of Dolakha district, in the mid-hills. You can bet they vote, too. 
They'll also beat you walking uphill. Both of them.

My mother-in-law is illterate and was married at age seven.
She has run for local office from a women's rights group.

Woman tempo driver, Kathmandu.
Tempos are the multi-seat motor rickshaws that are called tuk-tuks in Thailand
and by foreigners who don't know that's not what they're called here.

The girls of Mustang, coming on strong. 

All together now ........ Nepal! WE'RE 37th!

Oh whoops. No women in the picture. Hmmm.

Who Needs Math at a Vet's Office?

My dog Sandy is not a Siberian Husky. But don't tell that to the veterinarian's assistant.

This morning, on our regular walk, I noticed that Sandy had a worm in her poo. I am very sorry for writing two posts in a row that mention dog poo, but that's just how it goes sometimes. Be glad I didn't take pictures. It was long, white, wiggly, and busy. Having been unceremoniously dumped from its old home, the worm's little head was poking around in the air searching for a new set of cozy intestines.

That called for a walk to the vet's office. This is Nepal, so you don't call to make an appointment for a week from Thursday and bring the dog over for lab tests. You just walk over, minus dog, unless the dog is really sick. (Roundworms don't count around here. That would be like going to an ENT doc for the sniffles.)

An assistant was on duty. This is a rough transcript of the conversation, helpfully translated:

Me: My dog has worms. I need to get some de-worming pills.

Vet's Assistant: How many kilograms is your dog?

Me: Oh, I'm not good at converting from kilograms, but she's 25 pounds. You can convert it on the calculator.

Vet's Assistant: (Ignores calculator. Hands over three huge pills) Give her these.

Me: Wow, they're big. One each day?

Vet's Assistant: No, all at once Put them in some ground meat.

Me: That seems like a lot at once.

Vet's Assistant: Yeah, they're for 10 kg each.

Me: But she's only 25 pounds.

Vet's Assistant: 25 pounds. That's like 25 kg.

Me: Uh, no it's not.

Vet's Assistant: She must be a really big dog.

Me: No, not at all. She's a regular local dog. Do you know how to convert pounds to kg?

Vet's Assistant: (laughs, smiles, looks vaguely at calculator) Ha ha.

Me: Ha ha. Because I think three pills is too much medicine for my dog.

Vet's Assistant: Ha ha. Give it with some meat, she'll swallow it all that way.

Me: I think I'll go home and do the conversion myself.

Vet's Assistant: That'll be 150 rupees.

I went home and did the conversion. Well, first I asked The Teenager, who is quite possibly the worst student in his school in Math, and might be even worse than I was, which is some kind of world record -- and who, this being a weekend morning, was still in bed and not happy to be asked a mental math problem. "If Sandy is 25 pounds, how many kg is that?" said I to the sleepy teenager. "Mmph grrr. That's about 11 kg," he groused, and rolled over.

Indeed. And it turns out that 25 kg is around 55 pounds. Which is the weight of a Siberian Husky. So that's who should get the three pills. For reference sake, in case anyone stumbled onto this blog while training to be a Veterinary Assistant:

Siberian Husky.
I mean the one at the bottom
of the pic, with the fur and all.

Sandy. Not a Siberian Husky.

This is a cow. It is heavier than 25 Kg.
It goes "moo" and blocks traffic. That's how you know it's a cow.

Sandy has now had her de-worming medicine (adjusted for her actual body weight), ably administered by The Teenager. Think he can get a summer job as a vet's assistant?